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Whereas replacement of failed restorations is the major treatment for adults in dental practice, repair is an important alternative with the potential to save tooth structure and increase the longevity of restorations at a lower cost. This in vitro study recorded the choices of treatment for the same set of teeth with defective Class II amalgam restorations by students and faculty at two dental schools (University of Manchester, UK and University of Florida, USA). Treatment options (monitor, refurbish, repair and replace) and reason(s) for the choice of treatment for 24 marked amalgam restorations were selected. Overall, participants more frequently chose replacement of restorations; whereas, repair was the least favored option. The reasons cited the most to replace restorations were secondary caries including unsightly appearance, partially lost restoration and tooth fracture; for repair, the major reasons included loss of part of the restoration and marginal ditching; and for refurbishment, the major reasons included poor anatomic form and marginal ditching. There was a significant difference between the students and faculties at the two sites in their choice of treatment (p<0.0001; Chi-square test). The treatment decision to "monitor" the restorations was more frequent for the Manchester site than the Florida site. Conversely, the combined treatment decisions to "refurbish, repair and replace" were more frequently chosen in Florida than in Manchester.